Publication Spotlight: Dr. Jain

Read the below interview with Nishank Jain, MD, MPH, Assistant Professor, Division of Nephrology, University of Arkansas for Medical Sciences author of Comparative Effectiveness and Safety of Oral P2Y12 Inhibitors in Patients on Chronic Dialysis.

What question did your study aim to answer?

In this study, we wanted to compare effectiveness and safety of commonly prescribed antiplatelet medications (e.g., clopidogrel, prasugrel, and ticagrelor) in patients receiving chronic dialysis treatments.

What inspired you to conduct this study?

Patients on chronic dialysis were systematically excluded from the landmark drug trials in cardiovascular diseases. Compared to the general population, this study population is at a disproportionately higher risk of experiencing cardiovascular events and dying from them. Since antiplatelet drugs are commonly prescribed to patients on dialysis, and scarce data exist to compare choices of one drug over the other for in this population, we wanted to fill this knowledge gap in the literature.

Which USRDS datasets did you use to conduct your study?

We used patient files, treatment files and files including Part A, Part B, and D claims.

Using plain language, please summarize your study conclusions in two or three points.

• Compared to ticagrelor and clopidogrel users, prasugrel use was associated with a reduction in death from any cause among patients receiving chronic dialysis treatments.
• This mortality benefit of prasugrel was possibly related to the reduction in the risk for death from cardiovascular cause and for placement of stents in the heart.
• Since patients on chronic dialysis are at high risk of bleeding from use of antiplatelet drugs, we compared the differences in the risk of bleeding complications in this patient population with the use of P2Y12 inhibitors. Our results demonstrate no differences in the risk of bleeding complications between the drugs.
• Our work also lays groundwork for clinical trials investigating use of these drugs in patients on dialysis.

Please share a specific insight about working with USRDS data that you learned during the completion of this study.

USRDS data is well structured, and supporting documentation is helpful and thorough. Records of dialysis and transplant history are provided in USRDS data and contain important details about health history.